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Water safety and water security are essential for global human health. Access to water and sanitation is a basic human right, as recognised by the United Nations.
Absent, inadequate, or inappropriately managed water and sanitation services expose individuals to preventable health risks. This is particularly the case in healthcare facilities where both patients and staff are placed at additional risk of infection and disease when water, sanitation and hygiene services are lacking (WHO Drinking Water Factsheet).
Safe water is taken for granted in high-income countries such as the UK and EU nations where water is managed and provided by water utility suppliers to domestic and to healthcare and hospital settings. Once water enters healthcare buildings, a number of disciplines from design teams, estates and engineering, infection prevention and control, microbiology and scientific and research teams are involved in providing and maintaining a safe water environment. This is a challenging task. In 2012 an outbreak of Pseudomonas aeruginosa from water outlets in a neonatal ward in Belfast resulted in an inquiry that prompted development of guidelines under the Health Technical Memorandum (HTM), in particular HTM 04-01: Safe water in healthcare premises.
Since then, a number of waterborne microbiological risks, from Legionella pneumophila and Stenotrophomonas maltophilia to Burkholderia cepacia complex and Nontuberculous mycobacteria, have become a focus for improvements in legislation and surveillance in healthcare water systems. Multi-drug resistant organisms such as Carbapenemase producing enterobacterales (for example, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, and Citrobacter freundii) are increasingly reported as being transmitted from sinks and drains to vulnerable hospitalised patients. More recently, outbreaks of Cupriavidus species in healthcare waters has resulted in a public inquiry.
The healthcare facility is intended to protect and provide care, not only to patients, but also to their visitors and to all personnel providing care or maintenance of the building. The ability to provide safe water as part of this protective environment is facilitated by careful planning and design of complex water systems in new builds and refurbishments – which can be difficult and hugely expensive to fix if poorly implemented – along with systems to monitor and maintain water quality to minimize the transmission of pathogens in the clinical environment.
There is therefore a constant and pressing need for service improvement in healthcare-water system provision, which requires cooperation not just between government, NHS policymakers, and the medical, infection-control and scientific communities, but which also incorporates industry and the utilities and engineering sectors. Education and awareness are key drivers in improving healthcare water safety and service delivery.
The first pilot course was delivered in April 2024 for all involved in water safety, including IPC teams, estates, microbiology and infection specialists, engineering, construction, design, procurement and executive teams. After overwhelmingly positive feedback from participants, the course will now have a permanent place on HIS’s education programme.
The course is delivered by expert panels including:
insights from a multi-disciplinary team
Participation in the HIS Water Safety in Healthcare course will allow participants to access expert skills and knowledge, to network and to view real-life, data-driven approaches to water safety in healthcare settings.
Register for the next available course below.
Written by Dr Shanom Ali
Clinical Microbiology, UCLH Environmental Research Laboratory - UCLH NHS Foundation Trust
Associate Professor of Microbiology - UCL
FRMS